Personal Info Goals Health History Exercise History

Section 01 of 04

Personal Information

Please complete all fields. This information is kept strictly confidential.

First Name *

Last Name *

Phone *

Email *

Street Address

City

State

ZIP

Date of Birth *

How did you hear about us?

If referred, who can we thank?

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Section 02 of 04

Your Goals

Help us understand what you want to achieve so we can tailor your program from day one.

Primary goal *

Describe your goals in more detail

What has gotten in the way of achieving your goals in the past?

Anything else about your obstacles?

How many days per week can you commit to training?

Preferred training time(s)

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Section 04 of 04

Exercise History

Help us understand your background so we can meet you exactly where you are.

Current activity level *

Years of consistent training experience

What types of exercise do you currently do or have done?

Have you worked with a personal trainer before?

What did you like or dislike about previous training experiences?

Rate your motivation to change right now

Not motivated

Extremely motivated

Anything else you'd like us to know before your consultation?

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that this information will be used solely by Fuse Fitness to design a safe and effective training program. I acknowledge that I should consult a physician before beginning any exercise program if I have any doubts about my health status.

Full Name (as signature) *

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You're all set.

Thank you for completing your intake form. Our team will review your information before your consultation so we can make the most of our time together.

We look forward to meeting you.

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